I cover cardiology news for CardioExchange, a social media website for cardiologists published by the New England Journal of Medicine. I was the editor of TheHeart.Org from its inception in 1999 until December 2008. Following the purchase of TheHeart.Org by WebMD in 2005, I became the editorial director of WebMD professional news, encompassing TheHeart.Org and Medscape Medical News. Prior to joining TheHeart.Org, I was a freelance medical journalist and wrote for a wide variety of medical and computer publications. In 1994-1995 I was a Knight Science Journalism Fellow at MIT. I have a PhD in English from SUNY Buffalo, and I drove a taxicab in New York City before embarking on a career in medical journalism. You can follow me on Twitter at: @cardiobrief.

Cuban History Offers Important Lessons For Global Health Today

A large new study from Cuba shows the impressive benefits that can be achieved with weight loss and increased exercise. Much more ominously, the same study shows the dangers associated with weight gain and less exercise.

In the study, published in BMJ, researchers took advantage of a “natural” experiment that occurred in Cuba as a result of a major economic crisis in the early 1990s. Relying on 30 years of superb health statistics available in the country, the researchers analyzed the dramatic health effects associated with the economic crisis, which last from 1991 through 1995, and the subsequent recovery.

During the economic crisis caloric intake decreased and physical activity increased, resulting in a 5.5 kg reduction in weight and a very high (80%) proportion of the population classified as physically active. Following the crisis the pattern reversed itself: weight increased by 9 kg between 1995 and 2010 and today only 55% of the population is considered physically active.

Prior to the economic crisis the incidence of diabetes increased slowly. It then fell sharply during the crisis by 53%. The incidence of diabetes remained lower than before the crisis for several years but subsequently increased by 140% from 1996 to 2009. The changes in diabetes incidence were followed, after a lag, by similar changes in diabetes mortality.

From 1980 to 1996 mortality from coronary disease decreased by 0.5% per year. Following the crisis, from 1996 to 2002, mortality decreased by 6.5% per year. Subsequently the decline in the rate of mortality slowed to pre-crisis rates. Stroke mortality and all-cause mortality followed a similar pattern.

The authors were careful to note that the generalizability of their findings was “uncertain,” but said the “data are a notable illustration of the potential health benefits of reversing the global obesity epidemic.”

In an accompanying editorial, Walter Willett points out that other factors, including decreased cigarette smoking during the economic changes and other changes in the diet, may also have played a role in the health changes observed in the study. However, he writes, “the current findings add powerful evidence that a reduction in overweight and obesity would have major population-wide benefits. To achieve this is perhaps the major public health and societal challenge of the century.”

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